不同临床分层下阴道松弛与盆腔器官脱垂患者的临床特征分析

Analysis of Clinical Characteristics of Patients with Vaginal Laxity and Pelvic Organ Prolapse under Different Clinical Stratifications

摘要: 目的：探讨不同临床分层下阴道松弛(VL)与盆腔器官脱垂(POP)患者的临床特征差异，为临床精准诊疗与个体化管理提供依据。方法：本研究收集2024年1月至2025年1月于内蒙古自治区人民医院妇科门诊就诊的327例女性患者的临床资料。依据阴道松弛程度及POP-Q分期将患者分为四组：轻度松弛无脱垂组、中重度松弛无脱垂组、轻中度脱垂组和中重度脱垂组，采用阴道松弛问卷(VLQ)评估主观松弛感，盆底功能障碍问卷简表(PFDI-20)评估症状负担，并结合POP-Q测量指标进行临床分层分析。结果：四组患者在PFDI-20总分、VLQ评分及POP-Q指标中的生殖道裂孔(gh)、会阴体长度(pb)方面比较，差异均有统计学意义(均P < 0.05)。PFDI-20总分随临床分层加重呈显著递增趋势，中重度脱垂组症状负担最重[153.13 (128.13, 176.04)分]；VLQ评分随分层加重呈下降趋势，以中重度脱垂组最为显著[2.00 (2.00, 3.00)分]；gh的显著扩大主要发生于中重度脱垂组[4.50 (3.75, 5.00) cm]，而pb的缩短在中重度松弛无脱垂组即已显现[2.50 (2.50, 3.00) cm]。结论：阴道松弛与盆腔器官脱垂在不同临床分层下的临床特征、主观症状负担及客观解剖学指标存在显著差异，二者相关但进展并非完全同步。联合应用VLQ、PFDI-20与POP-Q的综合分层评估，有助于临床识别和个体化分层诊疗患者。

Abstract: Objective: To investigate the differences in clinical characteristics between patients with vaginal laxity (VL) and pelvic organ prolapse (POP) under different clinical stratifications, so as to provide evidence for precise clinical diagnosis, treatment, and individualized management. Methods: Clinical data of 327 female patients who visited the gynecology outpatient clinic of Inner Mongolia Autonomous Region People’s Hospital from January 2024 to January 2025 were collected. Based on the degree of vaginal laxity and POP-Q stage, the patients were divided into four groups: mild laxity without prolapse group, moderate-to-severe laxity without prolapse group, mild-to-moderate prolapse group, and moderate-to-severe prolapse group. The Vaginal Laxity Questionnaire (VLQ) was used to evaluate subjective laxity sensation, the Pelvic Floor Distress Inventory-20 (PFDI-20) was used to assess symptom burden, and POP-Q measurements were incorporated for clinical stratified analysis. Results: There were statistically significant differences among the four groups in PFDI-20 total score, VLQ score, and POP-Q parameters including genital hiatus (gh) and perineal body (pb) (all P < 0.05). The PFDI-20 total score showed a significant increasing trend with worsening clinical stratification, with the moderate-to-severe prolapse group having the heaviest symptom burden [153.13 (128.13, 176.04)]. The VLQ score decreased with stratification severity, being most pronounced in the moderate-to-severe prolapse group [2.00 (2.00, 3.00)]. Significant enlargement of gh occurred primarily in the moderate-to-severe prolapse group [4.50 (3.75, 5.00) cm], whereas shortening of pb was already evident in the moderate-to-severe laxity without prolapse group [2.50 (2.50, 3.00) cm]. Conclusion: The clinical characteristics, subjective symptom burden, and objective anatomical parameters of VL and POP differ significantly under different clinical stratifications. The two conditions are correlated but their progression is not completely synchronous. A combined stratified assessment using VLQ, PFDI-20, and POP-Q can facilitate clinical identification and individualized stratified management of patients.